BILL NUMBER: AB 359	CHAPTERED  10/10/99

	CHAPTER   845
	FILED WITH SECRETARY OF STATE   OCTOBER 10, 1999
	APPROVED BY GOVERNOR   OCTOBER 8, 1999
	PASSED THE SENATE   SEPTEMBER 9, 1999
	PASSED THE ASSEMBLY   SEPTEMBER 9, 1999
	AMENDED IN SENATE   SEPTEMBER 7, 1999
	AMENDED IN SENATE   SEPTEMBER 3, 1999
	AMENDED IN SENATE   SEPTEMBER 1, 1999
	AMENDED IN SENATE   AUGUST 30, 1999
	AMENDED IN SENATE   AUGUST 25, 1999
	AMENDED IN ASSEMBLY   MAY 28, 1999

INTRODUCED BY   Assembly Member Aroner

                        FEBRUARY 11, 1999

   An act to add Sections 14110.55 and 14133.12 to, and to add and
repeal Section 14495.10 of, the Welfare and Institutions Code,
relating to developmental disabilities.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 359, Aroner.  Developmentally disabled persons:  health care.
   Existing law provides for the licensure and regulation of health
facilities, including an intermediate care facility/developmentally
disabled--nursing.
   Existing law provides for the Medi-Cal program, administered by
the State Department of Health Services, under which qualified
low-income persons are provided with health care services.  One of
the types of services for which Medi-Cal reimbursement is provided is
long-term health care facility services, including services provided
by an intermediate health care facility/developmentally
disabled--nursing.
   This bill would require the State Department of Health Services to
establish a pilot program to provide continuous skilled nursing
care, as defined, as a benefit of the Medi-Cal program, in accordance
with an approved federal waiver to be developed and requested by the
department no later than April 1, 2000.  The bill would provide that
the purpose of the pilot program is to explore more flexible models
of health facility licensure to provide continuous skilled nursing
care to developmentally disabled individuals in the least restrictive
setting.  The bill would require that not less than 10 facilities
approved by the department would participate in the pilot program,
and would exempt those facilities from licensure during their
participation in the pilot program.
   This bill would authorize the department to enter into contracts
for the provision of essential administration and other services, and
would exempt these contracts from certain requirements of the Public
Contract Code.  This bill would also authorize the department to
adopt emergency regulations to implement its provisions.
   This bill would also require the department to develop Medi-Cal
reimbursement rates for services provided to patients needing
continuous care in these facilities.  The bill would further require
the Director of Health Services to apply specified utilization
controls to these facilities.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  Section 14110.55 is added to the Welfare and
Institutions Code, to read:
   14110.55.  For the purposes of the pilot program established under
Section 14495.10, the department shall develop a reimbursement rate
for continuous skilled nursing care services provided by a
participating health facility to developmentally disabled individuals
who meet the federal waiver eligibility criteria.  The reimbursement
rate shall be determined in accordance with a methodology that shall
be developed by the department.  The department may elect to
establish individual patient-specific rates.
  SEC. 2.  Section 14133.12 is added to the Welfare and Institutions
Code, to read:
   14133.12.  (a) The director shall apply utilization controls to
continuous skilled nursing care services provided pursuant to the
pilot program established under Section 14495.10, including, but not
limited to, prior authorization and monitoring by the department.
Prior authorization shall ensure that continuous skilled nursing care
services are medically necessary, and that the provision of
continuous skilled nursing care will avoid a transfer to, or
placement at, a higher level of service.  Monitoring shall be
conducted by the department including, but not limited to, evaluation
of quality of life, health, safety, and well-being of the
beneficiary, and quality, efficiency, and cost effectiveness of the
continuous skilled nursing care services.  The department shall
consult with the State Department of Developmental Services and
regional centers to design monitoring efforts.
   (b) Payment of the reimbursement rates established pursuant to
Section 14110.55 shall be subject to all billing criteria of the
Medi-Cal program and the utilization controls set forth in this
section.
   (c) This section shall become operative only if the federal waiver
identified under Section 14495.10 is approved by the federal Health
Care Financing Administration.  The director shall maintain a record
of the satisfaction of this condition.
  SEC. 3.  Section 14495.10 is added to the Welfare and Institutions
Code, to read:
   14495.10.  (a) The department shall establish a pilot program to
provide continuous skilled nursing care as a benefit of the Medi-Cal
program, when those services are provided in accordance with an
approved federal waiver meeting the requirements of subdivision (b).
"Continuous skilled nursing care" means medically necessary care
provided by, or under the supervision of, a registered nurse within
his or her scope of practice, seven days a week, 24 hours per day, in
a health facility participating in the pilot program.  This care
shall include a minimum of eight hours per day provided by or under
the direct supervision of a registered nurse.  Each health facility
providing continuous skilled nursing care in the pilot program shall
have a minimum of one registered nurse or one licensed vocational
nurse awake and in the facility at all times.
   (b) The department shall submit to the federal Health Care
Financing Administration, no later than April 1, 2000, a federal
waiver request developed in consultation with the State Department of
Developmental Services and the Association of Regional Center
Agencies, pursuant to Section 1915(b) of the federal Social Security
Act to provide continuous skilled nursing care services under the
pilot program.
   (c) (1) The pilot program shall be conducted to explore more
flexible models of health facility licensure to provide continuous
skilled nursing care to developmentally disabled individuals in the
least restrictive health facility setting, and to evaluate the effect
of the pilot program on the health, safety, and quality of life of
individuals, and the cost effectiveness of this care.  The evaluation
shall include a review of the pilot program by an independent
agency.
   (2) Participation in the pilot program shall include 10 health
facilities provided that the facilities meet all eligibility
requirements.  The facilities shall be approved by the department, in
consultation with the State Department of Developmental Services and
the appropriate regional center agencies, and shall meet the
requirements of subdivision (e).  Priority shall be given to
facilities with four to six beds, to the extent those facilities meet
all other eligibility requirements.
   (d) Under the pilot program established in this section, a
developmentally disabled individual is eligible to receive continuous
skilled nursing care if all of the following conditions are met:
   (1) The developmentally disabled individual meets the criteria as
specified in the federal waiver.
   (2) The developmentally disabled individual resides in a health
facility that meets the provider participation criteria as specified
in the federal waiver.
   (3) The continuous skilled nursing care services are provided in
accordance with the federal waiver.
   (4) The continuous skilled nursing care services provided to the
developmentally disabled individual do not result in costs that
exceed the fiscal limit established in the federal waiver.
   (e) A health facility seeking to participate in the pilot program
shall provide care for developmentally disabled individuals who
require the availability of continuous skilled nursing care, in
accordance with the terms of the pilot program.  During participation
in the pilot program, the health facility shall comply with all the
terms and conditions of the federal waiver described in subdivision
(b), and shall not be subject to licensure or inspection under
Chapter 2 (commencing with Section 1250) of Division 2 of the Health
and Safety Code.  Upon termination of the pilot program and
verification of compliance with Section 1265 of the Health and Safety
Code, the department shall immediately reinstate the participating
health facility's previous license for the balance of time remaining
on the license when the health facility began participation in the
pilot program.
   (f) The department shall implement this pilot program only to the
extent it can demonstrate fiscal neutrality, as required under the
terms of the federal waiver, and only if the department has obtained
the necessary approvals to implement the pilot program and receives
federal financial participation from the federal Health Care
Financing Administration.
   (g) In implementing this article, the department may enter into
contracts for the provision of essential administration and other
services.  Contracts entered into under this section may be on a
noncompetitive bid basis and shall be exempt from the requirements of
Chapter 2 (commencing with Section 10290) of Part 2 of Division 2 of
the Public Contract Code.
   (h) This section shall remain in effect only until January 1,
2003, and as of that date is repealed, unless a later enacted statute
that becomes effective on or before January 1, 2003, deletes or
extends that date.
  SEC. 4.  Emergency regulations may be adopted as necessary to
implement this act, in accordance with the Administrative Procedure
Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of
Division 3 of Title 2 of the Government Code), and the adoption of
the regulations shall be deemed to be an emergency and necessary for
the immediate preservation of the public peace, health and safety, or
general welfare.  These regulations shall be transmitted directly to
the Secretary of State for filing and the regulations shall become
effective immediately upon filing.  Upon completion of the formal
regulation adoption process and prior to the expiration of the
120-day duration period of emergency regulations, the adopted
regulations shall be transmitted directly to the Secretary of State
with the rulemaking file and the certification of compliance as
required by subdivision (e) of Section 11346.1 of the Government
Code.
